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  1. Fulltext Methicillin-Sensitive Staphylococcus Sureus(MSSA) infection resulting in a rare case of osteomyelitis pubis in an elderly female: A case report
    Gan, Syang Pyng, Yap, Sheau Huey, Ch'ng, Shereen Suyin, Hazlyna Baharuddin
    JUMMEC, 2020;23(1):23-25.
    MyJurnal
    A 71-year-old lady with rheumatoid arthritis developed painful peripheral vasculitic neuropathy of the lower limbs and was treated with high dose steroid and cyclophosphamide. Eight months later, she presented with left hip and back pain for a week, with minimal relief from regular analgesia. Although the initial pelvic radiograph was normal, a repeat film performed two weeks later showed a destructive lytic lesion in the left pubic bone, confirmed as osteomyelitis with intramuscular collection by MRI. Cloxacillin was started empirically, and when the blood culture isolated methicillin-sensitive Staphylococcus aureus (MSSA), it was planned to be given for six weeks via a peripherally inserted central catheter. Despite an initial response, she became febrile on the fifth week of antibiotic therapy. Subsequent blood culture isolated Trichosporon asahii. Her condition deteriorated, and she succumbed on the fourth day of antifungal therapy. In conclusion, the diagnosis of osteomyelitis pubis, a rare complication of MSSA bacteremia, could be delayed in an atypical presentation.
  2. Associated Factors of Tophaceous Gout: A Study Involving 20 Primary Care Clinics in an Urbanized State in Malaysia
    Gan SP, Zain MM, Ch'ng SS, Hassan H, Wan Adib WF, Muzaid A, et al.
    Oman Med J, 2023 Jul;38(4):e528.
    PMID: 37736055 DOI: 10.5001/omj.2023.87
    OBJECTIVES: Gout is a treatable disease. A complication of untreated or poorly-controlled gout is tophi formation. We conducted this study to investigate the associated factors of tophaceous gout among patients who attended 20 primary care clinics in Selangor, an urbanized state in Malaysia.

    METHODS: We conducted a cross-sectional study from July to October 2019 that included all patients with gout who attended the clinics. Data on clinical demographics and laboratory results were collected. Comparison between tophaceous and non-tophaceous groups was performed using descriptive analysis.

    RESULTS: A total of 421 patients with gout were involved in this study, 83 (19.7%) patients had visible tophi and were categorized into the tophaceous group, while the other 338 (80.3%) patients were categorized into the non-tophaceous group. The majority of patients were male with a mean age of 57.6±12.8 years. Three factors found to be significantly associated with tophaceous gout were age at symptom onset [tophaceous (45.6±13.3 years) vs. non-tophaceous (49.7±13.9 years), p = 0.026], mean disease duration of gout [tophaceous (105.2±92.6 months) vs. non-tophaceous (77.6±88.6 months), p = 0.013], and baseline serum uric acid level [tophaceous (622.3±129.1 µmol/L) vs. non-tophaceous (582.6±102.3 µmol/L), p = 0.021].

    CONCLUSIONS: Tophaceous gout is associated with longer disease duration, higher baseline serum uric acid level, and younger age at symptoms onset. Hence, early initiation of urate-lowering therapy with a treat-to-target approach is crucial to prevent tophi formation.

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